Administration Of Calcium Carbonate Research Articles

Laser photobiomodulation for chemical stomatitis in intensive care patient: Case report

Chemical stomatitis is a type of traumatic injury caused by contact of chemical substances and drugs with oral tissues, resulting in clinically significant damage. This case reports a 14-year-old male patient with chronic kidney disease on renal replacement therapy (peritoneal dialysis) and using calcium carbonate via oral capsules for treatment. Due to peritoneal dialysis complications, the patient developed bacterial peritonitis, requiring intensive care unit admission and alteration of his dialysis therapy mode to hemodialysis. During the hospitalization period, significant oral lesions developed due to inadequate calcium carbonate administration, interfering with the evolution of the patient’s general health and requiring the assistance of a dental team for diagnosis and treatment. The patient was diagnosed with chemical stomatitis. During the clinical examination, ulcerated, bleeding lesions were observed on the lip, jugal mucous membranes, hard palate, and soft palate. Laser photobiomodulation was used as a treatment associated with a topical corticosteroid. Each region received ten 1 J/point, and 60 J of energy were delivered per day/session. In total, 480 J of energy were delivered with a total irradiation time of 4800 s. The patient reported considerable improvement in pain symptoms after the first laser-photobiomodulation session. After 8 sessions, the patient had improved, and laser photobiomodulation proved effective for treating oral lesions.

Unexpected Benefits in Single Institution Experience With Successful Implementation of a Standardized Perioperative Protocol in Pediatric Thyroidectomy.

Introduction:To illustrate how quality improvement can produce unexpected positive outcomes.Methods:We compared a retrospective review of perioperative management and outcomes of baseline 122 pediatric total thyroidectomies to 121 subsequent total thyroidectomies managed by an Electronic Medical Record protocol in a large, free-standing children’s healthcare system. Process measures included serum calcium measurement 6−12 hours postoperatively; parathyroid hormone measurement 6 hours postoperatively; preoperative iodine for Graves disease, and postoperative prophylactic calcium carbonate administration. In addition, we completed 4 Plan-Do-Study-Act (PDSA) cycles, focusing on implementation, refinement, usage, education, and postoperative calcitriol administration. The primary outcome included transient hypocalcemia during admission.Results:All perioperative process measures improved over PDSA cycles. Measurement of postoperative serum calcium increased from 42% at baseline to 100%. Measurement of postoperative PTH increased from 11% to 97%. Preoperative iodine administration for Graves disease surgeries improved from 72% to 94%. Postoperative calcium carbonate administration increased from 36% to 100%. There was a trend toward lower rates of severe hypocalcemia during admission over the subsequent PDSA cycles starting at 11.6% and improving to 3.4%. With the regular review of outcomes, surgical volume consolidated among high-volume providers, associated with a decrease in a permanent hypoparathyroid rate of 20.5% at baseline to 10% by the end of monitoring.Conclusions:In standardizing care at 1 large pediatric institution, implementing a focused quality improvement project involving the perioperative management of transient hypocalcemia in total thyroidectomy pediatric patients resulted in additional, unanticipated improvements in patient care.

Successful treatment with oral alfacalcidol supplementation for nutritional hypocalcaemia with protein‐losing enteropathy in a dog

AbstractProtein‐losing enteropathy is characterised by panhypoproteinaemia, mainly associated with small intestinal diseases. A homemade ultralow‐fat diet is effective for the short‐term treatment of protein‐losing enteropathy, especially if it is caused by intestinal lymphangiectasia. However, ultralow‐fat diet provides poor nutritional balance, including low calcium and vitamin D contents. A 7‐year‐old, neutered, female chihuahua showing repeated diarrhoea and panhypoproteinaemia was diagnosed with intestinal lymphangiectasia based on the dog's endoscopic histopathology. The dog was treated with immunosuppressants and ultralow‐fat diet. After 1.5 years of ultralow‐fat diet treatment, a transient seizure suspected to be associated with hypocalcaemia (albumin‐corrected total calcium: 5.9 mg/dl) occurred, with suspected nutritional secondary hyperparathyroidism, despite calcium carbonate administration. Oral alfacalcidol (active vitamin D3) was initiated. The hypocalcaemia improved within 28 days. Therefore, an oral alfacalcidol supplement should be considered as a reasonable therapeutic strategy in canine intestinal lymphangiectasia with hypocalcaemia.

The Effectiveness and Safety of Calcium Carbonate Use in Chronic Kidney Disease Patients with Normophosphatemia

Background: Patients with early and moderate stages of chronic kidney disease (CKD) have normal serum phosphate levels. Increased fibroblast growth factor-23 (FGF23) levels in these patients are responsible for maintaining normophosphatemia status by increasing the excretion of phosphate through urine. However, an increased serum FGF23 level is related to cardiomegaly, vascular calcification, CKD progression, and mortality. This study aimed to examine the effectiveness and safety of calcium carbonate use in stage 3 or 4 CKD patients with normophosphatemia. Methods: This double-blind randomized controlled trial (ClinicalTrials.gov identifier NCT03550534) included stage 3 or 4 CKD patients with normophosphatemia who visited the nephrology or endocrinology clinic at Dr. Cipto Mangunkusumo Hospital. Forty-six subjects were randomized to receive either calcium carbonate or placebo over a 12-weeks period. Urine phosphate, serum phosphate, serum calcium, and serum intact FGF23 levels were measured before and after the intervention. Results: The baseline characteristics of the two groups were similar, except for the higher prevalence of dyslipidemia in the placebo group. The CaCO3 group had shown reduced levels of FGF23 compared to the placebo group, -8.03 vs. 0.15 pg/ml respectively (p = 0.019). The median level of FGF23 showed a significant decrease only in the CaCO3 group. An increase in eGFR and a slightly decrease in urine phosphate were observed in the CaCO3 group; however, the data was found to be statistically not significant. No significant changes were noted in the serum calcium levels in both groups. Conclusion: The administration of calcium carbonate has been shown to be effective and safe for moderate CKD patients with normophosphatemia due to its effect in lowering FGF23 levels without escalating the serum calcium level.

Comparison of Sevelamer and Calcium Carbonate in Prevention of Hypomagnesemia in Hemodialysis Patients.

Background:Chronic kidney disease (CKD) is a life-threatening disease with numerous complications. Hemodialysis (HD) patients are prone to magnesium deficiency due to malnutrition, which can cause cardiovascular complications and increase mortality. The present study aimed to investigate the effects of sevelamer and calcium carbonate, as phosphate binders, on serum levels of magnesium, calcium, and phosphorus in HD patients.Methods:A parallel clinical trial was conducted on 54 patients undergoing HD at Kosar Hospital of Semnan. The inclusion criteria were end-stage renal disease (ESRD), alternative HD treatment for at least 3 months 3 times a week, and serum phosphate levels greater than 4.5 mg/dL. The participants were randomly assigned to two groups of sevelamer (n = 27) and calcium carbonate (n = 27). If the participants were taking a phosphate binder, they were asked to stop it for 3 weeks. Participants in the sevelamer group received 800 mg of sevelamer at most three times a day and those in the calcium carbonate group were treated with 500 mg of calcium carbonate at most 3 times a day. Before and 3 months after the intervention, the serum levels of calcium, magnesium, and phosphorus were measured through the Arsenazo method using the Pars Azmun kit in the Selectra auto-analyzer. Twenty-one patients in the sevelamer group and 22 patients in the calcium carbonate group finished the study.Results:The results showed that calcium carbonate and sevelamer increased serum magnesium level by 0.20 (P = 0.028) and 0.26 (P = 0.002), on average, which were statistically significant. The administration of calcium carbonate did not significantly change serum calcium levels (P = 0.53), whereas sevelamer reduced serum calcium levels by 0.23 (P = 0.017), on average. This reduction was statistically significant. The results also indicated that none of the calcium carbonate (P = 0.099) and sevelamer (P = 0.543) caused significant changes in serum phosphorus levels. The study findings showed no significant difference between the two groups in terms of changes in the serum levels of magnesium (0.590), calcium (0.116), and phosphorus (0.113).Conclusions:Both drugs (Sevelamer and calcium carbonate) prevented hypomagnesemia and increased serum magnesium levels, but no significant differences were found in blood levels of calcium, phosphorus, and magnesium compared to the two drugs. Considering the effect of magnesium on cardiovascular diseases, increasing the serum magnesium levels through the administration of calcium carbonate and sevelamer can prevent the likelihood of cardiovascular diseases. However, none of the studied drugs was superior to the other in this regard.

Hidden Hypocalcemia as a Risk Factor for Cardiovascular Events and All-Cause Mortality among Patients Undergoing Incident Hemodialysis

Lower corrected calcium (cCa) levels are associated with a better prognosis among incident dialysis patients. However, cCa frequently overestimates ionized calcium (iCa) levels. The prognostic importance of the true calcium status defined by iCa remains to be revealed. We conducted a retrospective cohort study of incident hemodialysis patients. We collected data of iCa levels immediately before the first dialysis. We divided patients into three categories: apparent hypocalcemia (low iCa; <1.15 mmol/L and low cCa; <8.4 mg/dL), hidden hypocalcemia (low iCa despite normal or high cCa), and normocalcemia (normal iCa). The primary outcome was the composite of all-cause death and cardiovascular diseases after hospital discharge. Among the enrolled 332 patients, 75% of the patients showed true hypocalcemia, defined as iCa <1.15 mmol/L, 61% of whom showed hidden hypocalcemia. In multivariate Cox models including other potential risk factors, true hypocalcemia was a significant risk factor (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.03–5.34), whereas hypocalcemia defined as corrected calcium <8.4 mg/dL was not. Furthermore, hidden hypocalcemia was significantly associated with an increased risk of the outcome compared with normocalcemia (HR, 2.56; 95% CI, 1.11–5.94), while apparent hypocalcemia was not. Patients with hidden hypocalcemia were less likely to receive interventions to correct hypocalcemia, such as increased doses of active vitamin D or administration of calcium carbonate, than patients with apparent hypocalcemia (odds ratio, 0.45; 95% CI, 0.23–0.89). Hidden hypocalcemia was a strong predictor of death and cardiovascular events, suggesting the importance of measuring iCa.

Impact of pharmacist‐led education sessions on the knowledge and practice of calcium carbonate administration among Malaysian chronic kidney disease patients

AbstractBackgroundCalcium carbonate (CaCO3) is the most used phosphate binder among chronic kidney disease (CKD) patients in Malaysian hospitals. Hence, it is crucial for patients to have adequate knowledge and practice of CaCO3 administration for effective phosphate‐lowering therapy. Patient education serves as a keystone in inducing positive changes in patients’ knowledge and practices.AimTo evaluate the impact of pharmacist‐led education sessions (PLES), an educational approach in improving patients’ knowledge and practices regarding CaCO3 administration.MethodA total of 57 CKD patients prescribed CaCO3 were enrolled in a prospective, cross‐sectional study at the nephrology unit of a public‐funded hospital in Penang, Malaysia. Their baseline knowledge and practices of CaCO3 administration were assessed using a validated questionnaire consisting of five questions in the knowledge and practice sections, respectively. A patient's total score of less than seven was considered unsatisfactory, and these patients were provided PLES by pharmacists experienced in kidney health. After an interval of 4 weeks, patients were reassessed with the same set of questions.ResultsThe median (interquartile range) knowledge and practice scores before PLES were 0 (0, 1) and 3 (3, 5), respectively, while the overall score was 4 (3, 5). A significant improvement was demonstrated after PLES in the knowledge score (3 (2, 4) (p &lt; 0.001)), practice score (5 (5, 5) (p &lt; 0.001)) and overall score (7 (6, 9) (p &lt; 0.001)). All the questions assessing CKD patients’ knowledge and practices showed significant improvement after PLES.ConclusionPharmacist‐led education sessions have an impact on improving CKD patient's knowledge and practices regarding CaCO3 administration.

Effects of auricular plaster therapy on quality of life in uremia patients after parathyroidectomy plus autograft

To observe the effects of auricular plaster therapy on quality of life in uremia patients after parathyroidectomy plus autograft (PTX+AT). A total of 34 uremia patients complicated with secondary hyperparathyroidism (SHPT) who received PTX+AT were randomly divided into an observation group and a control group, 17 cases in each one. The patients in the control group were treated with calcium supplementation after surgery, 1 to 2 mg/kg an hour; one day after surgery, the patients were treated with oral administration of calcium carbonate before meals, 1.5 g, three times per day, and calcitriol (0.5 to 4 μg/d) was added if necessary. None-heparin hemodialysis was performed for one week after surgery. Besides calcium supplementation, patients in the observation group were treated with auricular plaster therapy at Shenmen (TF4), Jiaogan (AH6a), Neifenmi (CO18) and Shen (CO10). The laboratory indexes, including immunoreactive parathyroid hormone (iPTH), calcium, phosphorus, and SF-36 questionnaire, including 8 dimensions of physical function (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), role-emotional (RE) and emotional well-being (EB), were observed before surgery and 1 week, 2 weeks, 4 weeks and 8 weeks after surgery in the two groups. The iPTH in the two groups was significantly decreased 1 week, 2 weeks, 4 weeks and 8 weeks after surgery, and the serum calcium and phosphorus were also improved to a certain degree (all P<0.05); however, the differences of iPTH, calcium and phosphorus between the two groups were not significant at each time point after surgery (all P>0.05).The PF, RP, BP, GH, VT, SF, RE and EB of SF-36 in the two groups before surgery were lower than the normal score; after surgery, each dimension of SF-36 were improved to some extent in the two groups (all P<0.05). Eight weeks after surgery, the improvement of PF, RP, BP, GH and EB in the observation group was superior to that in the control group (all P<0.05); however, in terms of VT, SF and RE, no significant difference was observed between the two groups (all P>0.05). The auricular plaster therapy can improve the physical and mental health, relieve pain and improve quality of life in patients with uremia after PTX+AT, which is superior to calcium carbonate alone.

The Role of Calcium in Ameliorating the Oxidative Stress of Fluoride in Rats.

The present study was carried out to investigate the effects of fluoride toxicity on some biochemical, hormonal, and histological parameters of female rats and the protective role of calcium against such effects. Adult female albino rats were divided into five groups; control group received distilled water for 60days, calcium group received calcium carbonate with dose of 50mg/kg three times per week for 60days, fluoride group received sodium fluoride with dose of 20mg/kg three times per week for 60days, calcium + fluoride group received calcium carbonate (50mg/kg) then after 2h received sodium fluoride (20mg/kg) three times per week for 60days, and fluoride + calcium group received sodium fluoride (20mg/kg) three times per week for 30days then received calcium carbonate (50mg/kg) three times per week for another 30days. The results showed that the levels of thiobarbituric acid reactive substances, urea, creatinine, alkaline phosphatase, triiodothyronine, thyroxine, parathormone, phosphorous, magnesium, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma glutamyl transferase were significantly increased in rats treated with fluoride while serum estradiol, calcium, and organ glutathione were significantly decreased. The histological examination of the femur bone revealed that fluoride treatment induced thinning of bone trabeculae with wilding of marrow space, demineralization, and loss of trabeculae interconnections. Also, the histological examination of hepatic and renal tissues of fluoride-treated rats showed some damages in these tissues while administration of calcium carbonate for 30 or 60days during fluoride treatment minimized such damages. It could be concluded that administration of calcium to female rats can ameliorate the hazardous effects of fluoride observed in the biochemical, hormonal, and histological parameters.

Hypocalcemia: a reversible cause of T wave alternans and heart failure

We have read with great interest the recent article “Cellular mechanism of cardiac alternans: an unresolved chicken or egg problem” by Zang and Xia (2014), published in Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology). The authors proposed that both calcium handling and electrical components of cardiac cells could be the cellular mechanism of cardiac alternans, and identifying the main mechanism of cardiac alternans could help to cure targeted patients with heart failure. Here, we present a particular case, which may help you to understand our viewpoint.

An intact parathyroid hormone–based protocol for the prevention and treatment of symptomatic hypocalcemia after thyroidectomy

BackgroundSymptomatic (SX) hypocalcemia after thyroidectomy is a barrier to same day surgery and the cause of emergency room visits. A standard protocol of calcium and vitamin D supplementation, dependent on intact parathyroid hormone (iPTH) levels, can address this issue. How effective is it? When does it fail? MethodsWe performed a retrospective review of the prospective Thyroid database from January 2006 to December 2010. Six hundred twenty patients underwent completion thyroidectomy or total thyroidectomy and followed our postoperative protocol of calcium carbonate administration for iPTH levels ≥10 pg/mL and calcium carbonate and 0.25 μg calcitriol twice a day for iPTH <10 pg/mL. Calcium and iPTH values, pathology, and medication were compared to evaluate protocol efficacy. A P value <0.05 was considered statistically significant. ResultsUsing the protocol, sixty-one (10.2%) patients were chemically hypocalcemic but never developed symptoms and 24 (3.9%) patients developed breakthrough SX hypocalcemia. The SX and asymptomatic groups were similar with regard to gender, cancer diagnosis, and preoperative calcium and iPTH. The SX group was significantly younger (39.6 ± 2.8 versus 49 ± 0.6 y, P = 0.01), with lower postoperative iPTH levels. Thirty-three percent (n = 8) of SX patients had an iPTH ≤5 pg/mL versus only 6% (n = 37) of ASX patients. Although the majority of patients with a iPTH ≤5 pg/mL were asymptomatic, 62.5% (n = 5) of SX patients with iPTH levels ≤5 pg/mL required an increase in calcitriol dose to achieve both biochemical correction and symptom relief. ConclusionsProphylactic calcium and vitamin D supplementation based on postoperative iPTH levels can minimize SX hypocalcemia after thyroidectomy. An iPTH ≤5 pg/mL may warrant higher initial doses of calcitriol to prevent symptoms.

Calcium supplementation attenuates citrate-related changes in bone metabolism: A placebo-controlled crossover study in healthy volunteers

Citrate is the anticoagulation of choice in apheresis procedures. Citrate anticoagulation results in a short-term increase in serological markers of bone turnover, with uncertain clinical significance. To understand the effect of calcium supplementation on serological bone turnover markers during an acute citrate load as a mimic of citrate anticoagulation during apheresis procedures. A placebo-controlled, crossover study was conducted in 22 healthy volunteers. Volunteers received a standardized citrate load at a fixed dose of 1.5 mg/kg of body weight/min for 80 min for three times and a single placebo infusion as a control. Each intervention was separated by a wash-out interval of 2 to 3 weeks. During two citrate infusions, volunteers received an additional calcium supplementation, consisting of either oral administration of calcium carbonate or an i.v. bypass infusion of calcium gluconate. Serial blood samples were collected for the determination of ionized calcium (iCa), intact parathyroid hormone (iPTH) and markers of bone remodeling, C-telopeptide of type 1 collagen (CTX) and osteocalcin (OC). The infusion of citrate without calcium supplementation resulted in an increase in the bone formation marker OC and the bone resorption marker CTX, in addition to the changes in iPTH and iCa. The administration of calcium by either oral administration or as an i.v. bypass infusion attenuated the observed changes in CTX, but showed no effects on the elevation of the bone formation marker OC. There was no difference in the attenuation of CTX between the two calcium formulations. However, the i.v. application of calcium gluconate had a superior effect in reducing the change of serum iPTH and iCa as compared to the oral administration of calcium carbonate. Calcium supplementation is an effective method in damping the citrate-related transient increase of the serological bone resorption marker CTX. As a mimic for the citrate-based apheresis procedure, our data may enforce the prophylactic application of calcium supplementation to attenuate the short-term elevation of bone resorption related to an acute citrate load.

Does Concomitant Administration of Sevelamer and Calcium Carbonate Modify the Control of Phosphatemia?

There is no guideline regarding the concomitant or distant administration of sevelamer and calcium carbonate. Our aim was to determine whether serum phosphate varied when sevelamer and calcium carbonate were administered concomitantly in comparison to administration at separate meals. Fourteen chronic hemodialysis patients were enrolled in this cross-over, randomized trial. Each subject underwent two four-week study periods. During the "concomitant" period, subjects were instructed to take both sevelamer and calcium carbonate together at each meal, whereas in the "separate" period, they were required to take them at separate meals. The order of the "concomitant" and "separate" periods was randomized. Phosphate-binding agents were stopped for a one-week washout period before each study period. The total dose of sevelamer and calcium carbonate for each subject remained the same for the whole duration of the study and had been determined according to their usual dose of phosphate binders. Patients were instructed to keep their usual eating habits constant and a nutritionist evaluated the daily phosphate intake three times per week. Dialysis parameters were kept constant. Pre-dialysis serum phosphate, calcium, bicarbonate, and albumin were measured at the end of each week. The average daily dietary phosphate intake remained unchanged throughout the study. At the end of the two study periods there was no significant difference in serum phosphate (1.50 +/- 0.46 mmol/L in the "concomitant" period vs. 1.51 +/- 0.31 mmol/L in the "separate" period, P = 0.97), calcium (2.26 +/- 0.19 mmol/L in the "concomitant" period vs. 2.27 +/- 0.15 mmol/L in the "separate" period, P = 0.64), calcium x phosphate product (3.36 +/- 0.94 mmol(2)/L(2) in the "concomitant" period vs. 3.41 +/- 0.71 mmol(2)/L(2) in the "separate" period, P = 0.84) and bicarbonate levels (21.5 +/- 3.3 mmol/L for the "concomitant" period vs. 21.6 +/- 3.1 mmol/L for the "separate" period, P = 0.81). Our results show that simultaneous administration of calcium carbonate and sevelamer does not decrease phosphate-binding capacity. Hence, patients can choose to take their phosphate binders concomitantly or at separate meals, according to their preference.

A large calcified retroperitoneal mass in a patient with chronic renal failure: liposarcoma with ossification

Here we describe a 65-year-old Japanese man with chronic renal failure (CRF) and a large, dense, calcified abdominal mass. The patient had a history of proteinuria, which was diagnosed as focal glomerulosclerosis. This diagnosis was confirmed by renal biopsy in 2002, with worsening renal function by July 2005 when a large area of calcification was detected on abdominal radiography, which further increased in size on follow-up radiography in December 2006. The calcified mass was surgically resected and histopathologically diagnosed as myxoid-type liposarcoma composed of dedifferentiated, myxoid, and well-differentiated components with areas of osseous metaplasia. Soft tissue calcifications and ossifications are often benign, but malignant tumors should be considered when the calcified mass is retroperitoneal, occurs in a patient with no history of chronic infection, and is not located near a large joint or associated with administration of calcium carbonate or a vitamin D derivative.

Buffering Effects of Calcium Carbonate as Clarified by Sevelamer Hydrochloride Monotherapy

This study was undertaken to examine the necessity of taking into account the acid-base balance to ensure safe switching from calcium carbonate to sevelamer hydrochloride in hemodialysis patients. Forty-two hemodialysis patients were divided into two groups: the sevelamer hydrochloride therapy group (n = 18; "monotherapy group") and the combined calcium carbonate plus sevelamer hydrochloride therapy group (n = 24; "combined therapy group"). Observation was continued for six months. Subsequently, treatment with calcium carbonate was resumed in the monotherapy group at a dose level equal to that used before the start of study, and the combined therapy group continued to receive combined calcium carbonate + sevelamer hydrochloride therapy for another six months. The monotherapy group showed marked metabolic acidosis (HCO(3)(-) level from 20.2 +/- 2.4 mmol/L to 17.7 +/- 0.5 mmol/L). While the acidosis also became worse in the combined therapy group, the decrease in serum HCO(3)(-) level was smaller in this group than in the monotherapy group. The monotherapy group showed rapid recovery from acidosis following resumption of calcium carbonate administration (HCO(3)(-) level from 17.7 +/- 0.5 mmol/L to 20.6 +/- 0.7 mmol/L). We analyzed the cause of acidosis by the Stewart-Figge approach, and it was found to be attributable to the elevation of the serum Cl(-) level. The results suggest that treatment with calcium carbonate shows some buffering effects. Calcium carbonate acts as a potent alkalizing agent. We therefore consider it advisable to use sevelamer hydrochloride in combination with calcium carbonate in hemodialysis patients.

Calcium load during administration of calcium carbonate or sevelamer in individuals with normal renal function

Under steady-state conditions urinary calcium (Ca) excretion corresponds to the Ca load in healthy subjects. However, in chronic haemodialysis patients reliable data on Ca load are not available. In these patients Ca-containing phosphate binders are suspected to play a role in the progression of arteriosclerosis via increased but not quantified Ca load. The present study evaluated the effect of calcium carbonate (CC) and sevelamer hydrochloride (SEV), a calcium-free phosphate binder, on serum Ca and urinary Ca excretion in healthy individuals. Twelve healthy male individuals were included in a monocentre, randomized, single-blind, placebo-controlled, three-way crossover phase I study. Concurrently with their meals, participants received 4 x 2 tablets of SEV (800 mg), CC (500 mg) or placebo for 6 days with 1-week washout between the treatment periods. During the study, weekly blood samples were taken and 24-h urine was collected each day for measurement of calcium, magnesium, phosphorus, chloride and iPTH. Mean daily urinary phosphorus excretion was significantly lower in subjects undergoing SEV treatment compared to those taking placebo (P < 0.001). Mean daily total urinary excretion of calcium was significantly higher in CC-treated participants compared to those receiving placebo (P < 0.001). Mean 24-h calcium excretion during the 6 treatment days was 6.60 +/- 2.62 mmol [265 +/- 105 mg] (CC) versus 5.15 +/- 2.16 mmol [206 +/- 87 mg] (SEV) versus 4.95 +/- 1.63 mmol [198 +/- 65 mg] (Placebo). Taking into account nutritional calcium intake estimated from dietary records fractional calcium absorption was 8.7% (CC), 13.3% (placebo) and 14.8% (sevelamer). Intake of calcium carbonate compared to placebo in contrast to sevelamer in healthy individuals was associated with increased total urinary calcium excretion indicating an increased calcium load due to increased intestinal calcium absorption.

Effects of salmon calcitonin in treatment of osteoporosis in patients undergoing dialysis

To investigate the prevalence of osteoporosis in patients undergoing maintenance dialysis and explore the safety and efficacy of salmon calcitonin in maintenance dialysis patients underwent with osteoporosis. Double-energy X-ray bone density meter was used on 256 patients undergoing maintenance dialysis, 126 males and 130 females, aged 60 +/- 14 (22 -79), to measure the bone mineral density (BMD) at the lumbar spine and femoral neck. 108 of them with the T values < -2.5 s were diagnosed as with osteoporosis, and then were randomly divided into 2 equal groups matched in baseline age, sex, mode of dialysis, and levels of iPTH, ALP, and BMD: control group receiving oral administration of calcium carbonate 1500 mg tid and rocaltrol 0.25 microg qn for 18 months, and experimental group, received subcutaneous injection of salmon calcitonin (50 U) three times a week in addition. The BMD levels of lumbar spine and femoral neck, and serum intact parathyroid hormone (iPTH), calcium, phosphorus, and alkaline phosphatase (ALP) were assessed before treatment and 3, 6, 12, and 18 months after treatment. (1) The osteoporosis rate of the 256 maintenance dialysis patients was 42.19%. (2) The osteoporosis rate of the 201 patients undergoing maintenance hemodialysis (MHD) was 47.76%, significantly higher than that of the 55 patients undergoing maintenance peritoneal dialysis (21.82%, P < 0.01). (3) At the end of the trial, there was a significant increase of BMD of lumbar spine and femoral neck in the experiment group compared with the control group. (4) Compared with the control group, the serum ALP, iPTH, and BGP levels 3, 6, 12, and 18 months after treatment were all significantly lower than the baseline level and those of the corresponding control groups (all P < 0.01). The serum calcium of the control group at the end of experiment increased significantly in comparison with baseline level (P < 0.05). (5) No adverse events were found after the treatment of salmon calcitonin. Salmon calcitonin effectively increases the BMD of the maintenance dialysis patients and is well tolerated.

Comment atteindre et maintenir les recommandations K/DOQI TM sur le métabolisme phosphocalcique chez les patients dialysés : une stratégie efficace

Introduction Recent publications have indicated that alterations in bone and mineral metabolism are known to participate to a high mortality rate in patients undergoing haemodialysis. A new therapeutic strategy is progressively undertaken in the dialysis unit over a 36 months period covering years 2002 to 2004. Methods This new strategy includes the prescription of non-calcium, non-aluminium phosphate binder, sevelamer hydrochloride, an increase in vitamin D analogues prescription and a moderation in calcium carbonate administration. Sixty patients participated to the entire study and are evaluated three times a year on the four K/DOQI TM parameters. Other indicators such as haemoglobin, bicarbonate, total cholesterol and HDL cholesterol levels were studied. Results At the beginning of the study, 7% of the patients achieved the four K/DOQI TM parameters. This proportion seemed identical to those observed in the major studies. But progressively with the new therapeutic strategy 13%, then 21%, and at the end of the study 35% reached the four criteria. Therapeutic calcium intakes decreased from 100 g per patient/month to 28 g per patient-month. Prescription of vitamin D analogues increased from 3,3 μg per patient-month to 18,3 μg per patient/month. At the end of the study 60% of the patients received sevelamer hydrochloride at the mean dosage of 4800 mg per day. Haemoglobin remains stable. Bicarbonate level decreased due to a minor prescription in calcium carbonate. Under statins the ratio total cholesterol/HDL cholesterol decreased to 3,3. Conclusion A modification in the therapeutic strategy offer to patients undergoing haemodialysis, the possibility to achieve the K/DOQI TM recommendations with the hope to obtain a beneficial effect on patient outcomes.

Effect of Sevelamer Hydrochloride on Markers of Bone Turnover in Japanese Dialysis Patients with Low Biointact PTH Levels

In hemodialysis patients, adynamic bone disease has been reported to be closely associated with low levels of parathyroid hormone (PTH) due to exposure to high levels of serum calcium following the administration of calcium carbonate (CaCO3) or vitamin D agents. This study was conducted to clarify the therapeutic effect of a non-calcemic phosphate binder, sevelamer hydrochloride (sevelamer), for hypoparathyroidism in hemodialysis patients with or without diabetes mellitus. Based on entry criteria, 40 Japanese chronic hemodialysis patients (22 males and 18 females with a mean age of 60.6, 14 diabetic patients and 26 non-diabetic patients) were switched from CaCO3 to sevelamer for 48 weeks. Serum calcium, phosphate, intact (i) PTH and PTH-(1-84) were analyzed. Bone remodeling activity was evaluated by determining intact osteocalcine (iOC), bone-specific alkaline phosphatase (BAP). The switch from CaCO3 to sevelamer significantly decreased the serum levels of calcium, resulting in the elevation of iPTH levels from 31+/-18 pg/mL to 95+/-96 pg/mL by 48 weeks. In contrast, serum phosphate levels remained similar to those in patients with CaCO3 treatment. Concomitantly, the levels of BAP and iOC were elevated. Further, these beneficial effects on bone turnover were observed in both diabetic and non-diabetic patients. Sevelamer reduced the calcium concentration and thereby increased PTH levels, resulting in the improvement of markers of bone turnover. The administration of sevelamer is of therapeutic benefit for the improvement of bone remodeling activity even in hemodialysis patients with diabetes.

Can selenium supplementation prevent colorectal cancer?

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